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Applying ethical standards to guide shared decision-making with youth athletes
  1. Clare L Ardern1,2,
  2. Hege Grindem3,
  3. Guri Ranum Ekås4,5,6,
  4. Romain Seil7,8,
  5. Michael McNamee9
  1. 1 Division of Physiotherapy, Linköping University, Linköping, Sweden
  2. 2 School of Allied Health, La Trobe University, Melbourne, Australia
  3. 3 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  5. 5 Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Science, Oslo, Norway
  6. 6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  7. 7 Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
  8. 8 Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
  9. 9 College of Engineering, Swansea University, Swansea, UK
  1. Correspondence to Dr Clare L Ardern, Division of Physiotherapy, Linköping University, Linköping 581 83, Sweden; clare.ardern{at}

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Despite the vast quantity of information available to patients, parents and clinicians, high-quality information and knowledge remains in relatively short supply.1 The benefits of an active lifestyle are incontrovertible. However, youth athletes have substantial risk for sports-related injuries to the musculoskeletal system and the brain.2 3 These potential dangers are known to clinicians who are helping youth athletes and their parents make sound decisions about injury management and sports participation. In the face of these challenges, how does the clinician fulfil his or her duty of care to youth athletes?

The aim of this editorial is to illustrate how different ethical standards can help guide better shared decisions in sports medicine clinical practice. Youth athletes are a particularly vulnerable group because their life plans are still developing. Adding to this complexity is an increasing trend towards professionalisation in youth sport. When arriving at a decision in a clinical dilemma, one or several ethical standards may help the decision-making team evaluate if a decision is ethically justifiable. The 2018 International Olympic Committee consensus on paediatric ACL injury4 outlined six ethical standards (box 1) that may apply to different situations in sports medicine clinical practice.

Box 1

Six ethical standards that can apply to sports medicine clinical scenarios

  1. Best interests 5: what is in the youth athlete’s best long-term interests.

  2. Harm principle 6: a threshold below which the clinician should not acquiesce to a parent-led …

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  • Contributors All authors made substantial contributions to overall conception, planning, drafting and critically revising the manuscript. CLA, HG and MMcN wrote the first draft. CLA is the guarantor.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.